Gero-Health assessment of older adult chapter 7 Flashcards
What is the “FANCAPES” assessment and what is it used for?
- Comprehensive Physical Assessment Tool for Older Adults
- Determine basic needs; Functionability to meet those needs.
What does the “F” in FANCAPES stand for? What is commonly asked in this section?
- “Fluid” or hydration
- What is the current state of hydration?
-Does the person functional capacity to consume adequate fluids, ability to sense
thirst, obtain needed fluids, and swallowing and excreting them?
What does the “A” in FANCAPES stand for? What is commonly asked in this section?
- Aeration
- Pulmonary & Cardiovascular (oxygen stats, SOB/deep breathing, chest pain, cyanosis, pressure, HR, RR)
- Is the person’s oxygen exchange adequate oxygen saturation of >92%?
- Is supplemental oxygen required?
- What is the respiratory rate & depth at rest and during activity, talking, walking, exercising, and while performing ADLs?
What does the “N” in FANCAPES stand for? What is commonly asked in this section?
- Nutrition
- (lack of protein is a major issue, they can’t chew as well of they don’t like certain things; no protein means they get healthier and become weaker- leads to frailty and morbidity)
- What mechanical and physical factors are affecting the person’s ability to obtain and benefit from adequate nutrition?
- What is the type and amount of food consumed?
- Does the person have the ability to bite, chew, and swallow?
- What impact does the oral health status or periodontal disease have?
- For edentulous persons, do the dentures fit properly and are they worn?
- Does the person understand the need for special diets?
- Has the diet been designed so that it is consistent with the person’s eating and cultural patterns?
- Can the person afford the special foods needed?
- If the person is at risk for aspiration, including those who are tube fed, have preventative strategies been taught?
What does the “C” in FANCAPES stand for? What is commonly asked in this section?
- Communication
- (Ability to communicate- Can they speak to you?, Hear you?, Visually (can they point) can alter their self care)
- Is the person able to communicate his or her needs adequately?
- Do the care providers understand the person’s form of communication?
- What is the person’s ability to hear in various environments?
- Are there any environmental situations in which understanding of the spoken word is inadequate?
- If the person depends on lip-reading, is his or her vision adequate?
- Does the person have either expressive or receptive aphasia, and if so, has a speech pathologist been made available?
- What is the person’s reading comprehension and auditory comprehension level?
What does the “A” in FANCAPES stand for? What is commonly asked in this section?
- Activity
- (Participate in physical activity, the ability to continue to ambulate safely, risk for fall increases, the need for assistive devices may rise)
- Is the person able to participate in the activities necessary to meet basic needs such as toileting, grooming, and meal preparation?
- How much assistance is needed, if any, and is someone available to provide this?
- Is the person able to participate in activities that meet higher levels of needs such as belonging or finding meaning in life?
- What is the person’s ability to voluntarily move about with or without assistive devices?
- Does the person have the coordination, balance, ambulatory skills, finger dexterity, grip strength, and other capacities necessary to participate fully in day-to-day life?
What does the “P” in FANCAPES stand for? What is commonly asked in this section?
- Pain
- (Physical, emotional, spiritual (one rarely occurs in isolation; when you hurting physically you may be hurting emotionally)
- Is the person experiencing physical, psychological, or spiritual pain?
- Is the person able to express pain and desire for relief?
- Are these cultural barriers that make the assessment or expression of pain difficult?
- How does the person customarily attain pain relief?
What does the “E” in FANCAPES stand for? What is commonly asked in this section?
- Elimination
- Constipation; Incontinence (can result from cognitive changes that may cause a reduced, or even nonexistent, sensation indicating a need to void or defecate)
- Is the person having difficulty with bladder or bowel elimination?
- Is there a lack of control?
- Does the environment interfere with elimination and related personal hygiene?
- Are any assistive devices used, and if so, are they available and functioning?
- If there are problems, how are they affecting the person’s social functioning?
What does the “S” in FANCAPES stand for? What is commonly asked in this section?
- Social Skills
- Interactions with others
- Is the personable to negotiate relationships in society, to give and receive love and friendship, and to feel self-worth?
What is the “SPICES” assessment and what is it used for?
- Useful for determining areas where further assessment is needed.
- Not a “stand alone” tool- may direct/lead to the use of other evaluation tools (yes/no)- answering.
S is for Sleep Disorders P is for Problems with Eating or Feeding (Nutrition) I ncontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown
What kind of assessments are “SPICES” assessment & “FANCAPES” assessment?
-Physical Assessment Tools
What kind of assessments are “KATZ” assessment, “IADL-Lawton” assessment, “FAST” assessment?
-Functional Assessments
What is the “KATZ” assessment and what is it used for?
-Measures ADL and ability to complete independently or dependently
- independently/ no supervision (1 point)
- inability to complete/ need supervision (0 point)
- Score of 6 indicates full function
- Score of 4 indicates moderate function
- Score of 2 or less means severe functional impairment
Bathing Toileting Dressing Transferring (bed to chair, chair to bed) Feed themselves Continent
What is the “FAST” assessment and what is it used for?
- Functional Stage of Alzheimer’s and Dementia
- STAGE 1 no functional impairment associated with cognitive impairment - STAGE 7 unable to perform ADLs associated with sever late stage cognitive impairment
- reliable/ valid tool for evaluation of functional decline in persons with Alzheimer’s.
What are the 7 functional stages of Alzheimer’s and Dementia?
- Normal adult- no decline
- Normal older adult- very mild memory loss (loose keys/purse)
- Early dementia- memory loss starts to become apparent to coworkers, family members (forget bdays, what boss told them to do, forgetting what they went to do)
- Mild dementia- having finance problems/ having problems planning events
- Moderate dementia- need more time to survive, having problems with dressing and picking appropriate clothing, not able to assess and decide, can’t remember address and date.
- Moderate Severe dementia- names, forgetting family, needs help with ADLs, they’re sleeping through the day and staying up the night, become aggressive, blaming others, arguing with them does no good.
- Severe Dementia- speech is lost, incontinence, loss of ability to walk, bed ridden, contracting others, infection occurs (UTI and pneumonia), septic and die
What kind of assessments are “MMSE” assessment, “GDS” assessment?
-Screens for cognitive impairment
What is the “MMSE” assessment and what is it used for?
- Tell them three words to use (simple words: cat, dog, pencil, Tv)
- Tell them to draw a clock (give them an exact times; 10mins after 11)
- Then ask them to repeat the words; 1 point for each word
- Then you look at the clock pic; 2pts/normal (sequence in numbers are correct and the hands are correct) 0pts/abnormal
- These tools do not diagnose; set them up a follow-up to see someone who can diagnose them
Clock Drawing Test: Constructional Apraxia - An indicator of Alzheimer’s Disease
What is the “GDS” assessment and what is it used for?
-Assess satisfaction with life beyond physical health
MAY LEAD to increase functional decline, and health problems
- Really need this one with you when you are doing an assessment in nursing home
- Ask the pt not the caregiver unless pt can’t communicate
- Yes or no ?
- If the answer is answered that has a bold (yes/no) then that’s when you get a point
- 5 is a suggestion of depression
- Being a female put them at risk
Vulnerability
- They will recognize physical vulnerability before cognitive threat
Physical vulnerability
o Increasing vulnerability to environmental risks and mistreatment by others as older adults become less physically or cognitively able to cope or recognize real or potential hazards
o Trying to get them dress and they don’t want to; they will see you as trying to physically hurt them and they become defensive fast
Criminal vulnerability
Violent (they tend to live alone, memory impairment, live alone (loneliness causes them to invite people in)
o Family
o Stranger
Fraud vulnerability
·Fraudulent Schemes Against Elders ( cognitive) can they make reasonable decisions
·Children, siblings, other family members
·You may have to step in and call protective service
Environmental vulnerability
o Neurosensory changes (diminished/ delayed perception of the environment)
o Physiological changes (can’t warm themselves up or cool themselves down)
o Medications (alcohol will impair vaso-motor response; inhibit neuromuscular activities, suppress metabolic heat generation, and dull awareness to surroundings [they don’t shiver])
Temperature vulnerability
o Caretakers- to monitor their temp
o Economics- can they afford to turn the heat up or air?
o Fever: a one degree change from baseline may be significant in older adults
o Hypothermia: core temperature less than < 95 degrees F
· GOAL: Temp >97º
· More deaths occur from this because they don’t shiver
· Risks Box 20-6 p265
· Prevention Box 20-7 P 266
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o Hyperthermia: Ambient temperature greater than > 90 degrees F
▪ Prevention: Box 20-5 p 265
▪ Heat Syndromes: Table 20-1 P 264 heat fatigue, exhaustion, and stroke (medical emergency)
Safety vulnerability
· Home
o Fire: Box 20-4 p 263
·Transportation: Critical for the older adults to remain independent and functional
·Having reliability transportation
·Determination to stop driving is extremely difficult
·Social isolation
·Poor nutrition
·Neglect; can’t get their medicine
·Look for ride sharing agency
·Driving: A life changing event
What are the assistive technologies for older adults?
o Gerotechnology: term used to describe assistive technologies for older people
o Smart Homes
o Telemedicine
o Environmental control systems
What does it mean for older adults to age in place?
-the ability to live in one’s own home and community safely, independently, and comfortably.
What does it mean for older adults to age in community models?
- (Medicaid wants them here so they won’t have to pay for LTC or hospitals)
o Naturally Occurring Retirement Communities (NORCs)
o Village model
o Cohousing
o Shared housing
